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A Kjaeldgaard1), F Taheri -Johansson2), M Ankardal3)

No difference in urinary continence after surgery between retropubic and transobturatoric transvaginal sling operations when correcting for predisposing factors. A Kjaeldgaard1), F Taheri -Johansson2), M Ankardal3)

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A Kjaeldgaard1), F Taheri -Johansson2), M Ankardal3)

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  1. No difference in urinary continence after surgery between retropubic and transobturatoric transvaginal sling operations when correcting for predisposing factors A Kjaeldgaard1), F Taheri-Johansson2), M Ankardal3) Dept. Gynecol Obstet. 1)Karolinska University Hospital, 2)Värnamo County Hospital, 3)Sahlgrenska University Hospital , SWEDEN

  2. Material & Methods • Registerdata 2006-2009 from National Quality Register on Incontinence Surgery in Sweden • High validity (94% included, 8% drop-outs) • Questionaire preop, 2 months and 12 months - same questions asked every time • 4024 patients with 2months follow-up • 1935 of these have also one year follow-up • Continence the primary outcome • Chi 2 test. Significance level p <0,05)

  3. Risk groups • low risk: no risk factors • risk - Urge incontinence - History of incontinence or prolapse surgery - Hysterectomy • BMI > 30 • Elderly (age > 75 yy) • high risk: all risk factors present

  4. Continence at 2 and 12 months follow-up (unselected registerdata) • TVT superior already at 8 w (p<0.002) • TVT also better at one year (p<0.02) • No difference between TOT and TVT-O • Treatment results decrease only by a good 5% in one year

  5. Predisposing factors-A clinical problem seldomly adressed by RCTs • Urge incontinence ~60% • Over-weight ~20% • Over-aged ~10% • Previous vaginal surgery ~ 15% • Hysterectomy ~10% • TO has significant over-representation of risk factors > 80% of our patients present with some risk factor

  6. Risk group does matter when it comes to treatment results • No difference between TVs in low-risk patients • Slightly better (p<0,02) result for TVT in risk patients • Results are reduced by ~20% in the risk group • Only 50% continent in high risk patients Continence at 2 months follow-up related to risk group

  7. Influence of a single riskfactor on continence after 2 months Urge

  8. ConclusionsThe Swedish National Quality Register for Incontinence Surgery • In low risk patients all sling operations go very well • However >80% of our patients have some risk factor reducing treatment result at 2 months by nearly 20% • Significantly more patients with one or more risk factors are treated with transobturatoric methods • Previous hysterectomy is no risk factor • No influence of age per se can be demonstrated until >75 yy. • Presenting with all risk factors reduces postoperative continence at 2 months follow-up from nearly 90% to less than 40% • RCTs will not tell us the fate of the many risk patients

  9. Influence of a single riskfactor on continence after 2 months

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